Co-Creation of HIVST Delivery Approaches for Improving Urban Men’s Engagement with HIV Services in eThekwini District, KwaZulu-Natal: Nominal Group Technique

Background: HIV self-testing (HIVST) is one of the recommended approaches for HIV testing services, particularly for helping reach populations who would not normally access facility-based HIV testing. HIVST must be tailored to different populations to ensure uptake. Objective: The main objective of this study was to develop an acceptable HIVST delivery strategy to help improve urban men’s engagement with HIV services. Methods: We invited key stakeholders for urban men’s HIV services to participate in a co-creation workshop aimed at developing HIVST delivery approaches for urban men, using eThekwini municipality as a study setting. We conducted purposive sampling to include health care users and health care providers, representing a range of views across the public sector and voluntary sector. We employed the Nominal Group Technique (NGT) method for data collection. The NGT workshop was conducted in two consecutive phases: phase one was focused on determining barriers for men’s engagement with the current/facility-based HIV testing services; phase two was aimed at determining HIVST delivery strategies. We used the results of the NGT to design a tailored HIVST strategy for urban men in eThekwini District. Results: Participants identified the following psychological factors as the most important barriers to uptake of HIV testing services by urban men: stigma, ignorance about the importance of testing and testing process as well as fear of positive test results. Key stakeholders suggested internal motivation strategies as a potentially effective approach to support HIVST delivery strategy. Guided by the NGT results, we designed a HIVST delivery strategy that is supported by a risk communication approach. Conclusion: We designed an evidence-based risk communication mobile health (mHealth) strategy coupled with SARS COV-2 self-testing tailored to improve men’s uptake of HIVST. A follow-up study to evaluate the feasibility of implementing these approaches is recommended.

Jordanian Men's Experience of Emotional Abuse in Marital Relationships: The Role of Marriage Length and Motivation

Though emotional abuse is one of the worst and most common types of intimate partner violence, it has not been investigated in Arabic literature. Thus, this study explored the prevalence of emotional abuse among married Jordanian men. Furthermore, the moderating roles of marriage length, marriage motivation, age, and area in the path to emotional abuse were investigated. An online survey was conducted using a random sample of Jordanian married men in Amman. A total of 1,003 participants with an average age of 42.51 and a marital relationship duration ranging from 1 to 53 years were selected. The results revealed that isolation was the most prevalent emotional abuse domain, followed by degradation, property damage, and sexual coercion. However, all emotional abuse domains were more prevalent among rural rather than urban men, in both traditional and love marriages. Emotional abuse was higher among men who married for love. Younger men reported experiencing higher emotional abuse levels, which declined with age and increasing marriage length. Further research is required to explore the nature of emotional abuse forms and their underlying reasons among married men, as differences in sociodemographic characteristics could affect the identification and understanding of emotional abuse and contribute to developing an intellectual framework capable of finding solutions for abusive marital relations in the Jordanian context.

Co-creation of HIVST Delivery Approaches for Improving Urban Men’s Engagement with HIV Services in eThekwini District, KwaZulu-Natal: Nominal Group Technique

Background: HIV self-testing (HIVST) is one of the recommended approaches for HIV testing services, particularly for helping reach populations who would not normally access facility-based HIV testing. HIVST must be tailored to different populations to ensure uptake. Objective: The main objective of this study was to develop an acceptable HIVST delivery strategy to help improve urban men’s engagement with HIV services. Methods: We invited key stakeholders for urban men’s HIV services to participate in a co-creation workshop aimed at developing HIVST delivery approaches for urban men, using eThekwini municipality as a study setting. We conducted purposive sampling to include health care users and health care providers, representing a range of views across the public sector and voluntary sector. We employed the Nominal Group Technique (NGT) method for data collection. The NGT workshop was conducted in two consecutive phases: phase one was focused on determining barriers for men’s engagement with the current/facility-based HIV testing services; phase two was aimed at determining HIVST delivery strategies. We used the results of the NGT to design a tailored HIVST strategy for urban men in eThekwini District. Results: Participants identified the following psychological factors as the most important barriers to uptake of HIV testing services by urban men: stigma, ignorance about the importance of testing and testing process as well as fear of positive test results. Key stakeholders suggested internal motivation strategies as a potentially effective approach to support HIVST delivery strategy. Guided by the NGT results, we designed a HIVST delivery strategy that is supported by a risk communication approach Conclusion: We designed an evidence-based risk communication mobile health (mHealth) strategy coupled with SARS COV-2 self-testing tailored to improve men’s uptake of HIVST. A follow-up study to evaluate the feasibility of implementing these approaches is recommended.

Gender, Geography, and Justice: Behavioral Health Needs and Mental Health Service Use Among Women in Rural Jails

This multi-jail study examines the behavioral health needs and service use in a sample of 3,787 individuals in jail, to compare women in rural jails to their gender and geography counterparts (that is rural men, urban women, and urban men). Compared to urban women (17.9%, n = 677), rural men (18.2%, n = 690), and urban men (56.1%; n = 2,132), rural women (7.6%, n = 288) had significantly higher odds of serious mental illness and co-occurring mental health and substance use disorders. Rural woman were nearly 30 times more likely to receive jail-based mental health services; however, a discrepancy between screened mental health need (43.1%, n = 124) and jail-identified mental health need (8.4%, n = 24) shows rural women are severely under-identified compared to their gender/geography counterparts. These findings have implications for the changing nature of jail populations and suggests the need to improve behavioral health identification methods.

Masculinity Attitudes Across Rural, Suburban, and Urban Areas in the United States

This article uses the 2011–2019 National Survey of Family Growth to explore how masculinity attitudes differ by rural, suburban, and urban contexts across three social axes: sexual identity, race/ethnicity, and education. It examines within-group differences based on spatial context among 17,944 men aged 15–44 who are straight, gay/bisexual, Black, white, and Latino, as well as among men with less than a bachelor’s, a bachelor’s, and more than a bachelor’s. This contributes to existing knowledge in several ways: it is the first project to build on important qualitative studies through the use of a nationally representative sample; it contributes to the scarce research on how rural gay/bisexual, Black, and Latino men understand masculinity; and it examines how education shapes the relationship between spatial context and attitudes about masculinity. Results indicate that spatial context has a stronger relationship to attitudes among white men, straight men, and men without a bachelor’s than among Black men, Latino men, gay/bisexual men, or men with a bachelor’s or above. Theoretically, what this shows is that spatial context is more strongly related to masculinity attitudes for men who are advantaged on the basis of sexuality or race than for men who are marginalized on these axes. When significant differences emerged, rural men were more conservative than urban and suburban men, and suburban men were more conservative than urban men. These results show that there is a relationship between spatial contexts and attitudes about masculinity, but that it depends on social identity and level of education.

COMPARATIVE ANALYSIS OF INCOME DIFFERENTIALS BETWEEN MEN AND WOMEN IN URBAN AND RURAL HOUSEHOLDS IN BAYELSA STATE, NIGERIA.

This study was carried out across Bayelsa State on the comparative analysis of income differentials between men and women in rural and urban households, to examine the level of income earned by women relative to that of men in rural homes and in urban/semi-urban homes, as well as make a comparative analysis between both. Structured questionnaires were used to collect primary data, using a modified multistage random sampling procedure, from each of 160 rural and urban homes, giving a total of 320 respondents across the eight local government areas (LGAs) in the state. Descriptive statistics, in the form of ranges, averages, totals and percentages were used to analyze data. Findings revealed that women earn an average of N708,335.00 in rural homes and N932,612.87 in urban homes, while men on the average, earn N1,234,828.13 and N1,406,031.25 in rural and urban homes respectively. Conclusively, across homes in Bayelsa State, men generally, with an average proportion of about 62%, earn more than women with 38%; Similarly, across the state, men in rural homes earn an average of 63.5% compared to women who earn 36.5%; while in urban Bayelsa, the proportions are 60% and 40% for men and women respectively. Thus, indicating that rural women earn less than urban women in both value and proportion, while rural men earn lower income but higher proportion of the total household income than urban men.

Identifying “What Matters Most” to Men in Botswana to Promote Resistance to HIV-Related Stigma

Despite a comprehensive national program of free HIV services, men living with HIV in Botswana participate at lower rates and have worse outcomes than women. Directed content analysis of five focus groups ( n = 38) and 50 in-depth interviews with men and women with known and unknown HIV status in Gaborone, Botswana in 2017 used the “what matters most” (WMM) and “structural vulnerability” frameworks to examine how the most valued cultural aspects of manhood interact with HIV-related stigma. WMM for manhood in Botswana included fulfilling male responsibilities by being a capable provider and maintaining social status. Being identified with HIV threatened WMM, which fear of employment discrimination could further exacerbate. Our findings indicate how cultural and structural forces interact to worsen or mitigate HIV-related stigma for urban men in Botswana. These threats to manhood deter HIV testing and treatment, but interventions could capitalize on cultural capabilities for manhood to promote stigma resistance.

Depression and Anxiety-Free Life Expectancy by Sex and Urban–Rural Areas in Jiangxi, China in 2013 and 2018

Objective: To quantitatively estimate life expectancy (LE) and depression and anxiety-free life expectancy (DAFLE) for the years 2013 and 2018 in Jiangxi Province, China, by sex and urban–rural areas. Additionally, to compare the discrepancy of DAFLE/LE of different sexes and urban-rural areas over various years. Methods: Based on the summary of the health statistics of Jiangxi Province in 2013 and 2018 and the results of the 5th and 6th National Health Service Surveys in Jiangxi Province, the model life table is used to estimate the age-specific mortality rate by sex and urban–rural areas. Sullivan’s method was used to calculate DAFLE. Results: Data from 2013 indicate that those aged 15 can expect to live 56.20 years without depression and anxiety for men and 59.67 years without depression and anxiety for women. Compared to 2013, DAFLE had not fluctuated significantly in 2018. The proportion of life expectancy without depression and anxiety (DAFLE/LE) declined between 2013 and 2018. DAFLE/LE in urban areas was higher than in rural areas. Men had higher DAFLE/LE than women. From 2013 to 2018, the DAFLE aged 15 decreased by 0.18 years for urban men and decreased by 0.52 years for urban women, rural areas also decreased to varying degrees. Conclusions: Even if women had a longer life span than men, they would spend more time with depression or anxiety. DAFLE did not increase with the increase in LE from 2013 to 2018, suggesting an absolute expansion of the burden, especially in rural areas. Depression and anxiety health services in Jiangxi, China will face more serious obstacles and challenges, which may lead to more disability. This requires more attention and more effective measures from the public, medical departments and the government.

The values and meanings of social activities for older urban men after retirement

Previous studies have indicated that older men often experience disconnection from the community after retirement. Social activities have been shown to be effective in preventing social isolation among older urban men. Nevertheless, it has been reported that they often do not participate in community social activities and tend to be reluctant to do so. We explored the values and meanings of social activities for retired older men living in an urban area of Japan to understand support using social activities that are more suitable for them. Semi-structured interviews were conducted with 15 older men (aged 68–80 years; M = 74.6 ± 3.79 years) about their interactions with family and non-family members, and their participation in various community social activities. The grounded theory approach was used for the analysis. As a result, the following five categories were derived as the values that participants place on the social activities that they engage in: “health as a resource and reward for social activities,” “feeling I am still useful,” “feeling that something is my responsibility,” “feeling of time well spent,” and “finding interest through interactions.” In addition, the following three categories were extracted as meanings of social activities: “fulfilling social life,” “maintaining stable family relationships,” and “maintaining safety and peace in the community.” When considering the social activities that older urban retired men are interested in and likely to participate in, these five values can be considered indicators. In contrast, to maintain stable family relationships and safety and peace in the community, participants sometimes used strategies to stop or abandon social activities. Therefore, in situations where a peaceful life within a family or neighborhood is threatened, it may be useful to help set aside sufficient time and allow for psychological leeway in advance to incorporate social activities into their lives.